Phytomenadione

Phytomenadione is evaluated for the following indications with varying evidence strength: Vitamin K deficiency bleeding (evidence tier A), Coagulopathy in cholestasis and malabsorption (evidence tier A), Reversal of warfarin anticoagulant effect (evidence tier A). See the full indication matrix with dosing and citations above on this page.

Common side effects of Phytomenadione (≥ 1 in 100): Injection-site irritation, Transient facial flushing, Altered taste. See the Safety section for uncommon and serious reactions.

FDA category C. FDA Category C. AEMPS allows phytomenadione in pregnancy for confirmed vitamin K deficiency or coagulopathy correction. HDN prevention in mothers with epilepsy on enzyme-inducing antiepileptics (phenytoin, carbamazepine) – additional oral phytomenadione 10 mg/day from 36 weeks.

Compatible (Hale L1). Phytomenadione transfers into milk in small amounts. Despite this, HDN prophylaxis in the newborn remains mandatory – milk content is insufficient for adequate infant K levels.

Phytomenadione is contraindicated in: Hypersensitivity to phytomenadione or product components; IV bolus administration without dilution is forbidden (risk of fatal anaphylactoid reactions, especially in children). Full list in the Safety section.

intramuscular K1 1 mg in the first hours of life is the unanimous recommendation of AAP, NICE, WHO, and Russian normal-pregnancy guidelines. Without prophylaxis, the late VKDB risk with intracranial haemorrhage is 4–7 per 100,000 live births. Oral regimens are acceptable when injection is refused but are less effective.

Vikasol is K3 (menadione sodium bisulfite), a synthetic molecule. In newborns, K3 causes haemolytic anaemia and kernicterus risk. AAP, ESPGHAN, and NICE explicitly state that only K1 (phytomenadione) is used for VKDB. International paediatric practice has not used K3 for decades. Russian package inserts still list Vikasol as a «vitamin K» drug – this is outdated practice.

this hypothesis came from a single Golding et al. 1992 paper. Subsequent large epidemiological studies (Roman 2002, Fear 2003, McKinney 2003) did not confirm the association. AAP in its position statement explicitly rejects the hypothesis. Refusing K1 prophylaxis based on this myth raises real VKDB risk.

different molecules, different target tissues, different indications. K1 (phytomenadione) acts on hepatic clotting factors – the only form for VKDB and warfarin reversal. K2 (menaquinone) acts on tissue Gla proteins – marketed for bones and vessels with weak clinical basis. They do not substitute for each other across indications.

in a healthy adult, vitamin K is not deficient and clotting factors synthesise normally. Supplemental K1 without a clinical indication has no effect. In patients on warfarin, supplemental K1 is dangerous – it disrupts anticoagulation.